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Introduction: The 'Inverse Care Law' suggests the availability of good medical care tends to vary inversely with the needs of the local population. Dr Julian Tudor Hart's observations related to lack of access to care for those in both socially deprived and geographically remote areas. In this study, we aim to examine if the 'Inverse Care Law' is still relevant to GP service provision in the Mid-West of Ireland., Methods: GP clinic locations in Limerick and Clare were identified using the Health Service Executive (HSE) Service Finder and geocoded. GeoHive.ie was used to determine Electoral District (ED) centroids across the Mid-West. The shortest linear distance to a GP clinic was calculated for each ED. PobalMaps.ie was used to determine population and social deprivation scores of each ED., Results: In total, 122 GP practices were identified across 324 EDs. The average travel distance to a GP clinic in the Mid-West is 4.7 km. Limerick City EDs had the smallest patient population per GP clinic and were all found to be within 1.5 km of a GP clinic. Proximity to GP clinics did not correlate with deprivation. However, by removing GP clinics from the analyses, it was possible to determine how vulnerable different areas (rural vs urban, deprived vs affluent) are to potential changes in GP clinic availability in the future., Discussion: People living in urban areas such a Limerick City have improved geographic accessibility to GP clinics compared with their rural counterparts. However, within urban areas assessed, GP clinics were rarely found in deprived areas. Therefore, remote and urban-deprived areas are far more vulnerable to negative proximity effects secondary to practice closures, suggesting the principles of the 'Inverse Care Law' may still be active in the Mid-West of Ireland.

Background: Medical School programme workloads challenge the physical and mental health of students particularly in compressed graduate entry programmes. There is evidence that physical activity (PA) can improve holistic care and help maintain wellness among medical students. We tested the feasibility of introducing an exercise programme to the medical school curriculum which would educate and promote health and well-being among its students., Methods: This study was conducted in a single graduate entry medical school at the University of Limerick (UL). The 'MED-WELL' programme was a six-week programme of 1 hour-long weekly sessions, each involving a different type of PA (45 min). These sessions were prefaced by an interactive lecture about how to incorporate exercise theory into daily medical practice (15 min). The study was conducted in a single graduate entry medical school at UL and involved year one and year two graduate entry medical students. Three parameters were used to test feasibility: 1. Recruitment and retention of participants, 2. Acceptability of the programme and 3. Efficacy in terms of health and well-being. The latter was assessed by administering questionnaires pre and post the intervention. The questionnaires used the following validated measurement scales: EQ-VAS; WHO-5 Well-Being Index; 3-item Loneliness Scale; Social Support Measure 3-item scale. Free text boxes also encouraged participants to discuss the merits of the programme., Results: In total, 26% (74/286 students) participated in the programme. Of those who participated, 69 students (93%) attended one or more sessions of the programme and completed questionnaires at baseline and at follow-up. Significant improvements were seen in scores after the programme in the WHO-5 Well-Being Index which increased from 63.2 (95%CI: 48-78.4) to 67.5 (95%CI: 55.1-79.9); (P < 0.01), the sleep scale which increased from 3.1 (95%CI: 2.2-4.0) to 3.5 (95%CI: 2.5-4.5); (P < 0.001), and the loneliness scale which decreased from 4.1 (95%CI: 2.7-5.5) to 3.5 (95%CI: 2.5-4.5); (P < 0.005). Students level of PA during a typical week also increased from 3.7 (95%CI: 2.1-5.4) to 4.0 (95%CI, 3.5-4.5); (P < 0.05)., Conclusion: This study has shown it is feasible to deliver this programme in a medical school's curriculum. The programme seems to be of benefit and is acceptable to students. Well-designed randomised controlled trials are needed to measure outcomes, durability of effect, and cost effectiveness.

Over the past 6 years, 18 neonates with a posterior urethral valve obstruction have been treated. The mortality has been markedly reduced by meticulous investigation, better medical management of renal failure, greater use of catheter drainage and simpler methods of valve ablation and reduction in the use of nephrostomy and ureterostomy. Mortality was 33%, but ther has been no mortality in the last 7 patients.

Foreign bodies may enter the body by various ways, yet migration in the body seldom occurs. A case is described where a Kirschner wire, which had been inserted in the shoulder joint, migrated through the pleural cavity and the diaphragm, apparently by force of gravity. It was subsequently easily removed by laparotomy.

A clinical evaluation in 59 ptients showed that the premoistened form of polyamide 6 nylon suture material (Ethilon; Ethicon) is significantly better for the closing of clean surgical skin incisions than the unmoistened form. The moistening agent presumably did not adversely affect wound healing.

A total of 515 patients with spinal cord injuries were admitted to the Conradie Hospital's Spinal Cord Injuries Centre during a 3-year period from September 1974 to September 1977. Intermittent catheterization was used for urinary drainage in all patients with incomplete lesions as initially assessed neurologically, and indwelling catheterization in those with complete lesions. Transcutaneous suprapubic Bonnano (stab) continuous catheter drainage was used in a random group of 24 male patients with complete neurological lesions. The majority of the patients were admitted within 24 hours of injury. The follow-up period varied from 1 to 4 years. At 3 months more than 50% of patients had a balanced neurogenic bladder and were catheter-free. At 12 months 19% of patients were still catheter-dependent for reasons explained. Bladder outlet operations were more frequent among patients with thoracic lesions and were indicated 3 times more often in patients with complete neurological lesions. Bladder outlet operations were performed on 8.6% of patients. Only 5 patients (1%) required permanent urinary diversion. A urodynamic work-up is no longer regarded as merely a research tool in the investigation of patients with neurogenic bladder dysfunction. Both urodynamic and videoradiological techniques are a prerequisite to proper management of the neurogenic urinary tract.

Four families of which 2 or more members were affected with primary vesico-ureteral reflux are reported. A multifactorial inheritance pattern subject to environmental factors is likely. Early examination and detection of the disorder in relatives at risk provide an opportunity to avoid the serious sequelae of vesico-ureteral reflux.

Resection for abdominal aortic aneurysm (AAA) is being performed with decreasing mortality and morbidity. A retrospective study on 82 consecutive patients with AAAs admitted during the period 1974-1977 shoowed that 66 had a non-ruptured aneurysm and 16 a ruptured aneurysm. The mean age of the patients was 66,7 years. Concomitant disease was frequent. Operative mortality aneurysms and 37% in the group with ruptured aneurysms.

Since 1956 many children with undescended testes have been treated at the Red Cross War Memorial Children's Hospital in Cape Town, and in this article the conesequent degree of fertility achieved by orchidopexy, the method of treatment, is appraised. In 567 children the condition was unilateral, and in 202 it was bilateral. Assessment of potential fertility in 76 unilateral and in 29 bilateral cases was mainly by semen analysis; the average age of the youths at the time of the examination was 19 years, and parenthood was therefore regarded as an unsuitable criterion for assessment. Four hundred and ninety-two youths had their condition reviewed, and the condition of 587 testes was assessed. The anatomical state of the testes was ascertained to help in the assessment, but also, and of greater importance, to obtain evidence of the usefulness of orchidopexy for cosmetic or psychological benefit. Biopsy of the affected testes, carried out in some, proved to be nor more informative than the anatomical appraisal, with regard to spermatogenesis. Two useful facts emerged from the study. About 10% of bilateral undescended testes are capable of normal spermatogenesis after orchidopexy, and 65% are sterile, while the fertility of persons with unilateral undescended testis is impaired, 28% having little hope of paternity, and 4% no hope at all.